More Insulin Use for Type 2 Diabetes With Analogs

The use of insulin among patients who have type 2 diabetes mellitus (DM) has grown in recent years-from 10% in 2000 to 15% in 2010-a study reported in JAMA has shown, largely because of the widespread adoption of insulin analogs. Out-of-pocket expenditures per prescription also increased, from a median of $19 to $36.

Kasia J. Lipska, MD, MHS, of the Yale University School of Medicine, New Haven, Connecticut, and colleagues used data from an administrative claims database of privately insured enrollees from throughout the United States (with more representation from Southern and Midwestern states) to examine trends in insulin use, out-of-pocket expenditures, and severe hypoglycemic events among privately insured US adults with type 2 DM. The analysis included adults 18 years and older with at least 2 years of continuous plan enrollment between January 2000 and September 2010.

During the study period, 123,486 patients filled at least 1 prescription for insulin-9.7% and 15.1% of adults with type 2 DM in 2000 and in 2010, respectively. Among the adults who used insulin, 96.4% filled prescriptions for human synthetic insulin in 2000 and 14.8% in 2010; 18.9% filled prescriptions for insulin analogs in 2000 and 91.5% in 2010. Use of animal insulin was less than 1% during all years.

The median out-of-pocket costs per prescription for all types of insulin increased from $19 in 2000 to $36 in 2010. Severe hypoglycemic events declined slightly over the study period; the difference was not statistically significant.

Short-acting insulin analogs for the treatment of patients with type 2 DM may offer flexible dosing and convenience compared with human synthetic and animal insulin, and long-acting analogs offer less nocturnal hypoglycemia, but both at greater cost, according to background information in the article.

“We found a large increase in the prevalent use of insulin analogs among privately insured patients with type 2 diabetes. The clinical value of this change is unclear,” the authors concluded.

The study appears in the June 11 issue of JAMA, a diabetes theme issue.